Israel Goldstein

Sonographic measurements of the umbilical cord and vessels during normal pregnancies

Sonographic measurements of the umbilical cord and vessels were performed in 368 uncomplicated pregnancies, and nomograms of their growth were constructed. All measurements were obtained in appropriate for gestational age fetuses in pregnancies with accurate dating. From the above measurements, an estimate of Whartons jelly quantity (expressed as square millimeters) was calculated. The nomograms presented add another biometric measurement of normally growing fetuses and may serve to differentiate between them and those who are found to have umbilical cord abnormalities.

Umbilical artery flow velocity during maternal cardiopulmonary bypass.

The fetal death rate associated with cardiac operations using cardiopulmonary bypass in pregnant women is as high as 9.5% to 29%. We present a case in which fetal heart rate and umbilical artery flow velocity waveforms were continuously monitored by transvaginal ultrasonography and analyzed in relation to events of the cardiopulmonary bypass. Our findings suggest that hypothermia during cardiopulmonary bypass has potentially deleterious effects on the fetus and should be avoided if possible.

The influence of prenatal ultrasound on the prevalence of congenital anomalies at birth

The objectives of the study were (1) to assess whether prenatal ultrasound examinations affected the prevalence of congenital anomalies at birth and the incidence of terminations of pregnancy for fetal anomalies and (2) to examine the detection rate of the main fetal anomalies. We studied all births and stillbirths with congenital defects, and all terminations of pregnancy for fetal anomalies in the Rambam Medical Center during a 5‐year period (1989–1993) and correlated them to ultrasound findings. There were 23 439 births during the study period. The incidence of newborns with anomalies decreased from 1·95 to 1·34 per cent (P < 0·01). The incidence of termination of pregnancy because of fetal anomalies increased from 0·35 to 0·83 per cent (P < 0·003) and the detection rate of malformations increased from 53·94 to 79·60 per cent (P < 0·001). It is concluded that terminations of pregnancy after ultrasound detection of fetal anomalies had an impact on the prevalence of anomalies in newborns. There was also continuing significant improvement in the detection rate of ultrasound examinations.

Intraamniotic infection in the very early phase of the second trimester

A total of 157 consecutive patients were studied in an effort to examine prospectively the incidence of asymptomatic intraamniotic infection in the early phase of the second trimester. All patients were referred for amniotic fluid karyotyping. In addition, the amniotic fluids were examined for Gram stain and were directly cultured on blood agar and MacConkey agar as well as in thioglycollate broth. We found positive amniotic fluid cultures in eight cases (5.09%); however, results of Gram stain examinations were negative in all amniotic fluid samples. The data indicate that there is no correlation between white blood cells in the amniotic fluid and positive amniotic fluid culture results. Only one pregnancy with positive amniotic fluid culture resulted in a septic abortion. Therefore we can suggest that intraamniotic infection can exist early in pregnancy, even with intact membranes, and in most cases without any clinical symptoms.

Simultaneous recording of fetal breathing movements and body movements in twin pregnancy.

Fetal breathing and body movements were simultaneously evaluated in twin pregnancies in order to determine to what extent these activities occur in a synchroneous pattern in both twin fetuses and if fetal position, presentation or sex have an influence on their behavior. Thirty healthy pairs of twins at 34-37 weeks of gestation were studied. Twenty-six percent of fetal body movements and 49% of breathing movements occurred simultaneously in both fetuses. The overall total simultaneous fetal activity rate was 53.3%. The length of breathing movements and total activity (summation of breathing and body movements) of the fetuses positioned on the right side of the uterus were significantly longer than in fetuses positioned on the left side of the uterus (p = 0.002) and (p less than 0.0001) respectively. This was also true for subgroups where only fetuses in the same presentation or of the same sex were compared. It is concluded that the fetus positioned on the right side of the uterus is more active and that fetal sex or presentation had no significant effect on intrauterine fetal activity in twin pregnancies.

Neonatal transverse cerebellar diameter in normal and growth-restricted infants

OBJECTIVE To assess the transverse cerebellar diameter (TCD) in preterm and term neonates with normal growth or growth restriction. METHODS TCD was sonographically measured after birth in 404 neonates born between 23 and 42 weeks of gestation. The study included two groups: Group 1: 334 appropriately grown for gestational age (AGA) neonates (both birthweight (BW) and head circumference (HC) were between the 3rd and 97th centiles), which were subdivided into two subgroups according to the HC measurements. Group 2: 70 small for gestational age (SGA) neonates (BW <3rd centile), were further divided into three subgroups according to HC measurements. RESULTS In Group 1 of AGA neonates, a linear growth function was observed between the TCD and GA (R = 0.914, P < 0.00001, TCD = 0.279 + 0.142 X GA), and between TCD and HC (R = 0.886, P < 0.00001, TCD = -0.333 + 1.777 X HC). The percentage of neonates with normal TCD (> or =10th centile) was more than 85% of the AGA and asymmetric SGA subgroups, and 60.7% of the microcephalic SGA subgroup (P < 0.02). CONCLUSIONS This study provides normative data of neonatal TCD across gestational age. TCD measurement via sonography is a new adjunctive criterion for objectively assessing gestational age in infants when a precise determination of gestational age is necessary. This is very important since utility of the TCD is effective for both AGA and asymmetric SGA infants.

Nomogram of Maxillary Bone Length in Normal Pregnancies

The aim of this study was to define normal ultrasonographic growth of the fetal maxillary bone throughout pregnancy as a basis for further studies and as normative data for assessing deviations in growth.

Measurements of the lower uterine segment during gestation

To establish normal values for the lower uterine segment (LUS) thickness and to recognize factors that may affect these values.

The fetal superior cerebellar vermian width in normal, growth-restricted and macrosomic fetuses.

Objectives : To obtain dimensions of the fetal superior cerebellar vermian width as a basis for further studies and for comparisons with deviation in growth. Study design : The study group included 266 normal pregnant women from 20 to 37 weeks of gestation. Several biometric measurements were obtained throughout pregnancy, including the fetal superior cerebellar vermian width. Forty-three growth-restricted and 30 macrosomic fetuses were included in this study. Results : A linear growth function was observed between the superior cerebellar vermian width and gestational age (GA) ( R = 0.859; p < 0.00001; y = -4.033 + 0.416 2 GA), transverse cerebellar diameter (TCD) ( R = 0.870; p < 0.00001; y = 0.404 + 0.223 2 TCD), biparietal diameter (BPD) ( R = 0.823; p < 0.00001; y = -3.086 + 0.155 2 BPD), head circumference (HC) ( R = 0.82; p < 0.00001; y = -3.21 + 0.434 2 HC), femoral length (FL) ( R = 0.843; p < 0.00001; y = -1.75 + 0.184 2 FL) and humeral length (HL) ( R = 0.824; p < 0.00001; y = -2.691 + 0.223 2 HL). The ratio between the superior cerebellar vermian width and the transverse cerebellar diameter remained constant throughout gestation. In all 43 growth-restricted and the 30 macrosomic fetuses, the dimensions of the fetal superior cerebellar vermian width remained within the normal range for the indexed gestational age. Conclusion : These results provide normative data for the fetal superior cerebellar vermian width in various dimensions and across gestational ages. In addition, growth of the superior cerebellar vermis remained normal in growth-restricted as well as macrosomic fetuses. Therefore, cerebellar vermian growth may be used adjunctively as a standard against which deviant fetal growth may be compared when precise gestational age determination is necessary.

Correlation of fetal movements with maternal posture

SummaryThe influence of maternal posture on fetal movements as subjectively recorded by women 32 to 41 weeks pregnant was studied. A total of 160 women recorded fetal movements for 90 minutes while standing, sitting and lying in six different sequences. Fetal movements were significantly reduced in the standing position. A standing—sitting—lying sequence caused the highest frequency of fetal movements.